Restoration of disk height through non-surgical spinal decompression is associated with decreased discogenic low back pain: a retrospective cohort study.
Perioperative Clinical Research Core, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA. firstname.lastname@example.org
Because previous studies have suggested that motorized non-surgical spinal decompression can reduce chronic low back pain (LBP) due to disc degeneration (discogenic low back pain) and disc herniation, it has accordingly been hypothesized that the reduction of pressure on affected discs will facilitate their regeneration. The goal of this study was to determine if changes in LBP, as measured on a verbal rating scale, before and after a 6-week treatment period with non-surgical spinal decompression, correlate with changes in lumbar disc height, as measured on computed tomography (CT) scans.
A retrospective cohort study of adults with chronic LBP attributed to disc herniation and/or discogenic LBP who underwent a 6-week treatment protocol of motorized non-surgical spinal decompression via the DRX9000 with CT scans before and after treatment. The main outcomes were changes in pain as measured on a verbal rating scale from 0 to 10 during a flexion-extension range of motion evaluation and changes in disc height as measured on CT scans. Paired t-test or linear regression was used as appropriate with p < 0.05 considered to be statistically significant.
We identified 30 patients with lumbar disc herniation with an average age of 65 years, body mass index of 29 kg/m2, 21 females and 9 males, and an average duration of LBP of 12.5 weeks. During treatment, low back pain decreased from 6.2 (SD 2.2) to 1.6 (2.3, p < 0.001) and disc height increased from 7.5 (1.7) mm to 8.8 (1.7) mm (p < 0.001). Increase in disc height and reduction in pain were significantly correlated (r = 0.36, p = 0.044).
Non-surgical spinal decompression was associated with a reduction in pain and an increase in disc height. The correlation of these variables suggests that pain reduction may be mediated, at least in part, through a restoration of disc height. A randomized controlled trial is needed to confirm these promising results. CLINICAL TRIAL REGISTRATION NUMBER: NCT00828880.
There is a way to predict the presence of a lumbar disc herniation how serious the herniated disc is.
It appears from a study by Vucetic and Svensson1 that only three physical signs are of real diagnostic value in predicting whether there is a lumbar disc herniation and the degree or grade of herniation.
This study was a prospective rather than a retrospective study on 163 consecutive patients operated on for probable herniated discs. The three signs were the range of lumbar sagittal motion, the Lasegue sign, and the crossed Lasegue sign. They found that these tests were significant for the presence of a herniation and the degree of herniation, but not accurate for the level of herniation.
Neurologic signs, while important for distinguishing between radicular and referred pain, are not of great value in diagnosing the grade or level of a herniation.2 One third of patients with an absent Achilles reflex had a hernia above L5-Sl and the diagnostic value of an absent Achilles reflex may decrease with age.3 The absence of an Achilles reflex is more reliable than a diminished reflex as a sign of disc herniation, and its diagnostic value increases markedly if correlated with diagnostic imaging.4 Although patellar areflexia is six to seven times more common in L3-L4 hernias than other levels, only one-quarter of the patients with this sign had L3-L4 hernias.1
The strongest indicator for the grade of hernia was the range of sagittal lumbar motion. The range of lumbar motion decreased with increasing grades of herniation. The range was negligible for protruded hernia (generalized bulge with root involvement), and progressively decreased with an extruded disc hernia (posterior ligament still intact) and sequestrated (complete hernia beyond the posterior ligament). The crossed Lasegue sign, which was meaningful only if it was associated with the unilateral positive Laseque sign, was also proportionate to the grade of the hernia. Therefore the use of both the lumbar range-of-motion and crossed Lasegue sign predicted 74 percent of uncontained (sequestrated hernias), and 68 percent of contained hernias (protruded and extruded). In this study the Lasegue was only considered positive if pain radiated to the foot.
- Vucetic N, Svensson O. Physical signs in lumbar disc hernia. Clinical Orthopaedics & Rel. Research. (333);192-201:1996.
- Deburge A, Benoist M, Boyer D. The diagnosis of disc sequestration. Spine 9;496-499:1984. In: Vucetic N, Svensson O. Physical signs in lumbar disc hernia. Clinical Orthopaedics & Rel. Research. (333);192-201:1996.
- Spangfort EV. The lumbar disc herniation. A computer-aided analysis of 2,504 operations. Acta Orthop Scand 142(Suppl):70-71, 1972; In: Vucetic N, Svensson O. Physical signs in lumbar disc hernia. Clinical Orthopaedics & Rel. Research. (333);192-201:1996.
- Hakeliu A, Hindmarsh J. The significance of neurological signs and myelographic findings in the diagnosis of lumbar root compression. Acta Orthop Scand 43:239-24, 1972: In: Vucetic N, Svensson O. Physical signs in lumbar disc hernia. Clinical Orthopaedics & Rel. Research. (333);192-201:1996.
By Dr. Warren Hammer, MS, DC, DABCO
Published in: Dynamic Chiropractic – March 10, 1997, Vol. 15, Issue 06